Financial Contributions Research Articles

What do people know and think about medical overuse? an online questionnaire study in Germany.

Medical overuse is defined as health care services that exceed the individual needs of patients and when the potential harms of medical interventions exceed their benefits. It has impacts on patients as well as on health care resources. To address medical overuse, it is important to understand the knowledge and experiences of overuse on the side of patients. What is the citizens' understanding of overuse? How do they assess its relevance, causes, consequences and potential solutions? A quantitative online survey was conducted. The participants were asked to state what they understand by medical overuse. Statements on causes, consequences and possible solutions were evaluated. Recruitment was carried out via a panel of a market research institute (Schlesinger Group). The survey was completed by 406 participants. In terms of age and gender, the sample corresponded to the distribution in the German population. The majority had never heard of medical overuse (58%). About 60% assumed that medical overuse means "too much medicine including overtreatment and overtesting". Medical overuse was mainly suspected for services not covered by the public health insurance system (56%), surgical interventions (45%) and medication prescriptions (37%). Reasons for medical overuse were seen in uncoordinated care and financial incentives, but also in the expectations of patients. The main problem with medical overuse was seen in rising health care costs, while harmful physical and mental consequences for patients were mentioned less often. In order to reduce medical overuse, little importance was attributed to a primary care based system or higher financial contribution of patients. Instead, stricter cost control on the side of physicians and better coordination between care providers were suggested as solutions. Differences in socio-demographic characteristics hardly showed any differences in response behavior. More than half of the respondents had never heard of medical overuse. Overuse was mainly associated with financial causes and consequences. It was not seen that overuse can be harmful for patients directly. The limited awareness of the problem of overuse probably is a barrier to tackling it effectively. Communicating the topic to the public might therefore be an effective start to mitigate medical overuse. Many citizens seem not to be familiar with the concept of medical overuse, especially not with the fact that it may directly cause harm to patients. Informing citizens about the harms of medical overuse might be helpful in mitigating it.

Is there equal employment opportunity in tourism? An evaluation of African students' perceptions of future careers

PurposePrior to the COVID-19 pandemic, African students studying tourism and hospitality internationally had diverse experiences in their professional endeavours. This study seeks to examine the effects of the COVID-19 pandemic on the career progression and perspectives of African undergraduate students specialising in higher education in the fields of tourism and hospitality.Design/methodology/approachThe study utilised qualitative content analysis, which involves subjectively interpreting text data by systematically categorising and coding it to identify themes or patterns.FindingsThe findings deviate from how the COVID-19 pandemic has affected the career advancement of African international students studying tourism and hospitality in North Cyprus. Consequently, most developing nations face an increased need for security measures. Tourists will pay higher prices to visit highly secure areas rather than risking their lives. This is one of the reasons why many students from developing nations choose to pursue their careers in developed countries.Practical implicationsIt is imperative for the governments of developing nations to make substantial financial contributions to the development of their respective tourism sectors. Augmented investment has the potential to allure international tourists, thereby generating employment prospects for the host economies. The lack of investment forces young individuals to pursue their education overseas. Furthermore, it is imperative for developing nations to enhance their security infrastructure.Social implicationsOur findings suggest that policymakers should establish a diverse management team that includes student employees to develop suitable strategies for industry management. Insufficient student inclusivity can result in a lack of dedication, whereas involving them in management strategies can contribute to the industry’s prosperity.Originality/valueThe findings obtained from this research can stimulate the formulation of strategies within the tourism industry to tackle the intersection of career obstacles.

Relevance of Inclusive Finance with Sustainable Development Goals (SDGs) Perspective of Maqashid Sharia

This research aims to find out the right financing scheme so that the implementation of SDGs is more optimal and beneficial for small communities. inclusive financial contributions (zakat, infak and alms) in realizing SDGs and their relevance in realizing SDGs from a sharia maqashid perspective. This study uses a combination of qualitative-quantitative methods and approaches. Quantitative data analysis used is a method of tabulation, composing coding and score of variables. While qualitative data analysis includes the stage of data reduction, presentation and withdrawal of conclusions The results of this study show that the implementation of SDGs is carried out by a joint financing scheme through government and non-government budgets, one of which is through the distribution of zakat. The contribution of zakat in the implementation of SDGs has been carried out by the National Zakat Agency (Baznas) in the form of independence programs, religious education, health and social care. The relevance of zakat in realizing SDGs with Sharia Maqashid is shown in aid programs organized by Baznas such as the Program (1) eliminating poverty, (2) ending hunger, (3) good health and well-being, (4) quality education, and (5) clean water and sanitation relevant to the SDGs Program.

COVID-19 and Christian Faith-Based Organizations in Great Britain: A Research and Resource Review of Organizational, Financial and Human Contributions and Impacts in the Context of a Wider “Christian Ecology”

The COVID-19 pandemic presented what, on both global and national levels, has arguably so far been the most extensive health, economic and social challenge of the 21st century. Responding to this challenge, it soon became clear that, while having a vital role in the contextual provision of necessary services, public authorities also needed to engage with organizations in the voluntary, community sector, including Faith-Based Organizations (FBOs). This article presents and discusses and analyzes a digest of research and resource evidence from the beginning of 2020–to the end of 2023 concerning the organizational, financial and human contributions of and impacts of the COVID-19 pandemic on, in particular, Christian FBOs in Great Britain. It goes on to analyze these contributions and impacts within the analytical framework of what it calls a wider “Christian ecology” as the context within which such FBOs live, to which they contribute, and, as argued by this review, apart from which they cannot be properly understood. Finally, in exploring some of the lessons to be learned from the evidence and analysis presented, the article identifies and considers some key opportunities and issues that arise at the interface between the work of (especially, but not only, Christian) FBOs and the structures and processes of the governmental powers-that-be.

Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

Developing a framework for understanding policy decision-making behaviors in the transition of a HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program

Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor support to the voluntary medical male circumcision (VMMC) program, which previously funded non-governmental organizations as implementing partners, is increasingly being directed through government structures instead. We developed a framework to understand how the behaviors of individual decision-makers within the government could be barriers to this transition. We interviewed key stakeholders from the national, provincial, and district levels of the Ministry of Health, and from donors and partners funding and implementing Zambia’s VMMC program, exploring the decisions required to attain a sustainable VMMC program and the behavioral dynamics involved at personal and institutional levels. Using pattern identification and theme matching to analyze the content of the responses, we derived three core decision-making phases in the transition to a sustainable VMMC program: 1) developing an alternative funding strategy, 2) developing a policy for early-infant (0-2 months) and early-adolescent (15-17 years) male circumcision, which is crucial to sustainable HIV prevention; and 3) identifying integrated and efficient implementation models. We formulated a framework showing how, in each phase, a range of behavioral dynamics can form barriers that hinder effective decision-making among stakeholders at the same level (e.g., national ministries and donors) or across levels (e.g., national, provincial and district). Our research methodology and the resulting framework offer a systematic approach for in-depth investigations into organizational decision-making in public health programs, as well as development programs beyond VMMC and HIV prevention. It provides the insights necessary to map organizational development and policy-making transition plans to sustainability, by explaining tangible factors such as organizational processes and systems, as well as intangibles such as the behaviors of policymakers and institutional actors.

Examining the implementation of facility-based integrated management of childhood illness and insecticide treated nets in Bangladesh: lessons learned through implementation research

BackgroundBangladesh significantly reduced under-5 mortality (U5M) between 2000 and 2015, despite its low economic development and projected high mortality rates in children aged under 5 years. A portion of this success was due to implementation of health systems-delivered evidence-based interventions (EBIs) known to reduce U5M. This study aims to understand how Bangladesh was able to achieve this success between 2000 and 2015. Implementation science studies such as this one provide insights on the implementation process that are not sufficiently documented in existing literature.MethodsBetween 2017 and 2020, we conducted mixed methods implementation research case studies to examine how six countries including Bangladesh outperformed their regional and economic peers in reducing U5M. Using existing data and reports supplemented by key informant interviews, we studied key implementation strategies and associated implementation outcomes for selected EBIs and contextual factors which facilitated or hindered this work. We used facility-based integrated management of childhood illnesses and insecticide treated nets as examples of two EBIs that were implemented successfully and with wide reach across the country to understand the strategies put in place as well as the facilitating and challenging contextual factors.ResultsStrategies which contributed to the successful implementation and wide coverage of the selected EBIs included community engagement, data use, and small-scale testing, important to achieving implementation outcomes such as effectiveness, reach and fidelity, although gaps persisted including in quality of care. Key contextual factors including a strong community-based health system, accountable leadership, and female empowerment facilitated implementation of these EBIs. Challenges included human resources for health, dependence on donor funding and poor service quality in the private sector.ConclusionAs countries work to reduce U5M, they should build strong community health systems, follow global guidance, adapt their implementation using local evidence as well as build sustainability into their programs. Strategies need to leverage facilitating contextual factors while addressing challenging ones.

Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality

BackgroundOver the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization’s (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda’s rapid uptake of these two EBIs developed or adapted during the study period.MethodsWe conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research.ResultsWe found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors.ConclusionImplementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.

THE EUROPEAN UNION’S LAWSUIT OVER THE 2020 PROHIBITION OF INDONESIAN RAW NICKEL ORE EXPORTS

This research discusses the reasons behind the European Union's lawsuit against Indonesia regarding the policy to ban the export of raw nickel ore in 2020. The background of Indonesia's ban on the export of nickel ore is part of the national plan to develop the domestic industrial sector, including stainless steel production. Based on this policy, the European Union implemented a foreign policy to sue Indonesia at the WTO, considering it a violation of the provisions of the WTO trade agreement under Article XI:1 of the GATT 1994. The method used in this research is a qualitative descriptive research method employing Robert Ghilpin's theory, which describes foreign policy influenced by domestic industry interests and external influences.The European Union's background as a stainless steel producer makes nickel the most significant value addition for the EU in terms of employment, taxes, investments, and product utility. Nickel's utility for the EU, simultaneously serving as a benefit, lies in high-performance technological products that leverage its characteristics of high heat resistance and durability. The comparison of the income results of the EU industry, which significantly impacts the economy, has experienced a decline since the implementation of Indonesia's export ban policy. Consequently, the European Union filed the lawsuit due to economic interests in the EU's domestic industry, such as labor absorption and financial contributions to the state.

Maslahah Perspective in the Distribution of Shared Wealth: Analysis of Judge's Decision Number 584/Pdt.G/2021/PA.Pwr

This study aims to analyze the implications and relevance of the perspective of maslahah in legal practice related to the division of common property in the context of the judge's Decision Number 584/Pdt.G/2021/PA.Pwr. This study uses the method of document analysis to analyze the judge's Decision Number 584/Pdt.G/2021/PA.Pwr and related legal contexts. The study's findings indicate that the perspective of maslahah has significant implications for the division of common property. In the decision of Judge Number 584/Pdt.G/2021/PA.Pwr, maslahah perspective is reflected in determining the ratio of 1/3 and 2/3 for the plaintiff and defendant. This decision can be interpreted as an attempt to achieve a fair division and consider each party's contribution in acquiring and maintaining the common property during the marriage or relationship. In addition, the perspective of maslahah is relevant in ensuring wisdom in the division of common property. Considering financial and non-financial contributions, financial needs and capabilities, and the children's best interests are important factors in achieving fair and sustainable distribution. Judge's decision Number 584/Pdt.G/2021/PA.Pwr. The Pwr is believed to have considered these factors in maintaining fairness and discretion in the division of common property.

Influence of reciprocal financial resources on shrimp fishers' income sources in Southern Nigeria

The study examines reciprocal financial relationships' influence on shrimp fishers' income sources and their motivation in Rivers State, Nigeria, fishing communities. A mixed methods design was employed using a semi-structured questionnaire, interview guide and checklist to collect data from 125 shrimp fishers and 20 Key informants. Data on shrimp fishers' financial contributions were subjected to UCINET 6.647 Net draw to generate a sociogram. Fishers' income sources and motivating factors were subjected to content analysis and multiple regression. The results showed that shrimp fishers in Rivers State pay dues, contributions and donations to obtain revolving loans from their network and receive remittances from relatives. The sums of money are invested in fishing equipment and off-fishing ventures. 44% of fishers relied on remittances and loans for investment. However, enabling institutional framework and support from external agencies are motivating factors to join a social network which aims at improving income sources among shrimp fishers in line with Sustainable Development Goals 16 and 17. Shrimp fishers who engage in a reciprocal financial relationship have their income sources improved by diversifying into off-fishing ventures. The study recommends that Shrimp fishers register as cooperatives to attract more support from government and donor agencies.

Public Procurement price variance in Kenya: extent, Drivers, and Proposed Mitigation

Developing economies, often dependent on donor funding and debt, such as Kenya could benefit from sealing budget leakages. Public procurement price variance is deemed a key inefficiency in public expenditure contributing to the loss of colossal amounts of Money. Mechanisms to achieve realistic public procurement prices are stipulated in the existing public procurement regulatory regime; However, Price variances, manifesting in inflated tenders, are abound. The extent and drivers are yet to be empirically examined. This study adopted an exploratory approach to examine the extent of public procurement price variance; by conducting variance analysis of market prices and prices of goods contained in procurement contracts of 336 public procuring entities (Ministries, Departments, and Agencies) in Kenya in the 2022/2023 Financial Year. Analysis of data drawn from a random sample of 40 MDAs, indicates that all items acquired by MDAs were overpriced: at between 20% and 220% of the market price. Analysis of drivers of overpricing ranked: “budgeted kickbacks/bribes”; “Response to Late Payments by MDAs”; “Collusive Bidding”; and “Over-use of non-competitive methods”; as key drivers. The study reviewed the price oversight mechanism of the public procurement system in Kenya and recommends the adoption of a live internal public procurement audit model to monitor and oversight pricing. This will require a review of the regulatory regime to entrench the internal procurement audit model into the public procurement process. The study also recommends a public procurement study to examine the extent and magnitude of procurement price variance across Kenya and its fiscal effect on the Economy.

Nature Forest Reserves in Tanzania and their importance for conservation.

Since 1997 Tanzania has undertaken a process to identify and declare a network of Nature Forest Reserves (NFRs) with high biodiversity values, from within its existing portfolio of national Forest Reserves, with 16 new NFRs declared since 2015. The current network of 22 gazetted NFRs covered 948,871 hectares in 2023. NFRs now cover a range of Tanzanian habitat types, including all main forest types-wet, seasonal, and dry-as well as wetlands and grasslands. NFRs contain at least 178 of Tanzania's 242 endemic vertebrate species, of which at least 50% are threatened with extinction, and 553 Tanzanian endemic plant taxa (species, subspecies, and varieties), of which at least 50% are threatened. NFRs also support 41 single-site endemic vertebrate species and 76 single-site endemic plant taxa. Time series analysis of management effectiveness tracking tool (METT) data shows that NFR management effectiveness is increasing, especially where donor funds have been available. Improved management and investment have resulted in measurable reductions of some critical threats in NFRs. Still, ongoing challenges remain to fully contain issues of illegal logging, charcoal production, firewood, pole-cutting, illegal hunting and snaring of birds and mammals, fire, wildlife trade, and the unpredictable impacts of climate change. Increased tourism, diversified revenue generation and investment schemes, involving communities in management, and stepping up control measures for remaining threats are all required to create a network of economically self-sustaining NFRs able to conserve critical biodiversity values.

Primary healthcare system and provider responses to the Taliban takeover in Afghanistan

IntroductionExisting health system challenges in Afghanistan were amplified by the Taliban’s August 2021 government takeover during which the country faced an evolving security situation, border closures, banking interruptions, donor funding...

Jersey, Guernsey and English Ecclesiastical Jurisdiction under Henry VII

Papal bulls transferring jurisdiction over the Channel Islands from the bishopric of Coutances (Normandy) first to the diocese of Salisbury and then to Winchester have an important place in the historiography of the allegedly centripetal forces of royal and ecclesiastical authority under Henry VII. This article corrects the chronology, and questions the disruptive impact of international tensions and the role of English bishops’ or governors’ ambitions. Instead, it points to the influence of Breton clergy. Further, that Henry abandoned the initiative for a financial contribution from the islanders sheds light on his policy towards his rights over the Church and beyond.

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study

PurposePopulation ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes.MethodsThe main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson’s Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster.ResultsThe variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of “poor” couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability.ConclusionThe results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

COTTAGE INDUSTRY IN DAKSHINA KANNADA: A CASE STUDY

A thorough contextual research of the Dakshina Kannada bungalow industry, examining its financial aspects and impact on neighbouring networks. India is among the worlds developing countries. In this context, trading plays a major role in resolving problems with Khadi items. In the unlikely event if the creators fulfil Khadis objectives to win over customers devotion by creating fresh, modern Khadi products, it usually becomes a major player in the home business. Generally speaking, it is said that home businesses are an unavoidable, backward aspect of the economy. However, a financial analysis and practical engagement with many other countries demonstrate that the bungalow enterprises have demonstrated remarkable perseverance and have made a significant financial contribution to the nation. The case for fostering the growth of the bungalow industry in Dakshina Kannada is clear because these businesses present excellent opportunities for generating a sizable amount of revenue and procure a valuable open door for relatively minimal price for unemployment, especially in rural areas. This supports efforts to achieve high and useful monetary development. KEYWORDS: Cottage Industry, Dakshina Kannada, Sustainable economic growth, Achieving High

Factors impacting sustained coverage inthe context ofdonor transitions: experience from Sri Lanka.

Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC's future financial sustainability within the current structure remain in the context of low malaria burden.

Managing transitions from external assistance: cross-national learning about sustaining effective coverage.

The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to this question, this paper analyses the process and outcomes of donor transitions in health-where countries or regions within countries are no longer eligible to receive grants or concessional loans from external sources based on eligibility criteria or change in donor policy. The comparative analysis of multiple donor transitions in four countries-China, Georgia, Sri Lanka and Uganda-identifies 16 factors related to policy actors, policy process, the content of donor-funded initiatives and the broader political-economic context that were associated with sustained coverage of previously donor supported interventions. From a contextual standpoint, these factors relate to favourable economic and political environments for domestic systems to prioritize coverage for donor-supported interventions. Clear and transparent transition processes also enabled a smoother transition. How the donor-supported initiatives and services were organized within the context of the overall health system was found to be critically important, both before and during the transition process. This includes a targeted approach to integrate, strengthen and align key elements of the governance, financing, input management and service delivery arrangements with domestic systems. The findings of this analysis have important implications for how both donors and country policy makers can better structure external assistance that enables sustained coverage regardless of the source of funding. In particular, donors can better support sustained coverage through supporting long-term structural and institutional reform, clear co-financing policies, ensuring alignment with local salary scales and engaging with communities to ensure a continued focus on equitable access post-transition.

Institutionalizing Innovation: From Pilot to Scale for Co-Packaged Oral Rehydration Salts and Zinc-A Case Study in Zambia.

We document the development and institutionalization in Zambia of a health innovation for diarrhea treatment aimed at children aged younger than 5 years: a unique oral rehydration salts and zinc (ORSZ) co-pack. Seven recommendations from the World Health Organization/ExpandNet are used retrospectively to analyze and describe the successful scale-up of this innovation from its concept stage, including in-country expansion and policy, institutional, and regulatory changes. The 7 recommendations comprise using a participatory process, tailoring to the country context, designing research to test the innovation, testing the innovation, identifying success factors, and scaling up. The scale-up of co-packaged ORSZ in Zambia is shown to be sustainable. Five years after donor funding ended in 2018, an independent, local manufacturer continues to supply the private and public sectors on a commercially viable basis. Furthermore, national coverage of ORSZ increased from less than 1% in 2012 to 34% in 2018. A key success factor was the continuous facilitation over 8 years (spanning planning, trial, evaluation, and scale-up) by a learning and steering group chaired by the Ministry of Health, open to all and focused on learning transfer and ongoing alignment with other initiatives. Other success factors included a long lead-in of inclusive initial consultation, ideation, and planning with all key stakeholders to build on and mobilize existing resources, knowledge, structures, and systems; alignment with government policy; thorough testing and radical review of the product and its value chain before scale-up, including manufacture, distribution, policy, and regulatory matters; and adoption by the government of a co-packaging strategy to ensure cases of childhood diarrhea are treated with ORSZ. With appropriate local adaptations, this approach to scale-up could be replicated in other low- and middle-income countries as a strategy to increase coverage of ORSZ and potentially other health products.